How Common Is Postherpetic Neuralgia
Varicella-zoster virus causes both chickenpox and shingles. About 99% of Americans over age 40 have had chickenpox. About one in three people in the U.S. develop shingles in their lifetime. Some 10 to 18% of people who get shingles will develop postherpetic neuralgia. Postherpetic neuralgia is the most common complication of shingles.
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How Is Postherpetic Neuralgia Treated
If shingles is caught within the first three days of its outbreak, your healthcare provider may prescribe the antiviral medication acyclovir , valacyclovir or famciclovir . These medications help the rash/blisters heal faster, keep new sores from forming, decrease pain and itching and reduce length of pain after sores have healed.
If your shingles outbreak is not caught early, your healthcare providers has many options to manage your postherpetic neuralgia symptoms.
If your pain is mild, your healthcare provider may recommend:
- Acetaminophen or NSAIDs such as ibuprofen .
- Creams and patches include lidocaine and capsaicin .
If your pain is more severe, your healthcare may prescribe:
- Antiseizure drugs gabapentin and pregabalin .
- Antidepressants, such as escitalopram , quetiapine or amitriptyline.
- Botulinum toxin injections in the area where you are having pain.
Theres no clear-cut superior treatment for PHN. Your provider may need to try more than one medication or prescribe the use of several medications at the same time. You and your provider will discuss options and what makes sense to try for you. Contact your provider if your pain is not lessening after taking your medicine. Take all your medications exactly as prescribed.
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Reducing Nerve Pain From Shingles
Pharmaceuticals and vaccination for herpes zoster.
Shingles is virtually synonymous with pain, whether it be from the rash itself, from postherpetic neuralgia , or postherpetic itch . Additionally, it can lead to serious complications involving the eye, including vision loss and blindness, as well as pneumonia, hearing problems, brain inflammation, and even death.
Treatment of the virus typically begins with antiviralsand the sooner the better. Acyclovir, valacyclovir, and famciclovir are most commonly used to treat shingles. They should be administered as quickly as possible after the onset of symptoms to shorten the severity and length of the illness.
Additionally, there are simple self-care steps that can be followed to help reduce the pain and discomfort of shingles.
Long-term nerve pain from PHN is the most common complication of shingles and is experienced by up to 20% of patients with shingles The risk of PHN increases with age, as does the severity and length of pain, which can persist for months or even years.
The FDA has approved the use of analgesics, anticonvulsants, and lidocaine and capsaicin topical patches for treating PHN.
PHI, which can occur in conjunction with PHN, is caused by sensory fibers in the nerves that were damaged or died during the shingles infection. The remaining isolated nerve fibers fire when they shouldn’t, generating false sensations that fool the central nervous system.
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Whats The Difference Between Cream Lotion And Ointment
Ointments, lotions, and creams are three types of substances you can apply to your skin to help manage shingles.
These topicals are similar, but there are slight differences in their makeup. The primary difference is the amount of water and oil they contain.
According to this 2016 primer, creams are made up of about equal parts oil and water and often have moisturizing properties. Theyre thicker than lotions but thinner than ointments.
Lotions are similar to creams, but they are made up mostly of water. They have less oil and have a thinner consistency. Because theyre thinner, your skin absorbs them more quickly. Some lotions are oil-free.
Ointments are the thickest of the three. They are made to stay on top of your skin instead of being absorbed immediately. Ointments are made up of at least 80 percent oil.
What Are The Three Stages Of Shingles
The stages of shingles are the early lesion, the vesicular stage, and the late stage.
The early lesion is the first sign of shingles and appears as a patch of red skin that may be sensitive to touch.
The vesicular stage is the next and is marked by the appearance of small red bumps on the skin, which are slightly cloudy and may have a yellowish tinge to them.
The late-stage is the last stage of shingles and is characterized by a rash of painful blisters, which crust over and eventually scab over.
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Antiviral Drugs May Help Relieve Nerve Pain Related To Shingles
- JAMA and Archives Journals
- A small trial suggests that treatment with intravenous and oral antiviral medications may reduce the nerve pain that occurs following shingles, according to a study posted online today that will appear in the July 2006 print issue of Archives of Neurology, one of the JAMA/Archives journals.
A small trial suggests that treatment with intravenous and oral antiviral medications may reduce the nerve pain that occurs following shingles, according to a study posted online today that will appear in the July 2006 print issue of Archives of Neurology, one of the JAMA/Archives journals.
Shingles is caused by the varicella-zoster virus, the same virus that causes chickenpox, according to background information in the article. The virus lays dormant in the nervous system for decades after infection with chickenpox. When it becomes reactivated, the virus causes a rash and nerve pain . Postherpetic neuralgia can that lasts for months or years and affects as many as one million people in the United States.
One month after therapy, eight patients reported that their pain had reduced significantly . This was similar to the percentage of patients who reported such an improvement after day 15 and after day 45 . Most patients tolerated the treatment well, although five dropped out of the study early, three of them because of complications related to the therapy.
. Available pre-embargo to the media at www.jamamedia.org)
The Emotional Toll Of Nerve Pain After Shingles
Researchers are not just looking at biological and neurological risk factors for PHN. Dworkin was also a co-author of a study looking at psychological risk factors, too. The results were published in the Journal of Pain in 2005.
“It certainly looks like psychological stress can be a potent risk factor for PHN,” Dworkin tells WebMD.
The study showed that people with shingles who went on to develop PHN were more likely to have had symptoms of personality disorders, hypochondria, intense worry about their disease, and other bodily complaints.
Dworkin says previous studies have already shown a connection between stress and shingles development.
“One study even found that the risk of developing PHN was higher in people who were living alone when they developed shingles than people living with others,” Dworkin says, perhaps indicating that social isolation increases the risks of PHN.
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How Quickly Does Gabapentin Work
Studies show that pain relief may start within one week and reach a maximum effect in about 4 weeks. It can take this long because gabapentin is usually started at a low dose and gradually increased over time until it works.
For treating neuralgia, gabapentin is often started at 300 mg per day and gradually raised by 300 mg per day. One 2017 review of 37 studies found that pain relief usually occurs at a dose of 1,200 mg or more.
The same review compared gabapentin to an inactive medicine in almost 6,000 adults with chronic pain from PHN or diabetic neuropathy. Study participants were given either gabapentin or a placebo for 4 to at least 12 weeks. The results showed that 30-40% of people taking gabapentin were able to reduce their pain by half or more, compared to 10-20% of people taking the placebo.
Although some people may get significant relief, others may have side effects without relief of pain. More than half of people taking gabapentin did not get significant relief and had side effects from the drug.
According to the review, about 60% of people taking gabapentin had side effects, including:
- Water retention
- Clumsiness while walking
It does not typically make pain worse: In trials comparing gabapentin side effects to placebo side effects, only 1% of people reported increased pain, and this was the same for gabapentin and placebo.
Risk Factors For Nerve Pain After Shingles
Researchers have long known that older people are more likely to get PHN, the nerve pain after shingles, but recent studies have found other factors that increase risks.
In one study published in the journal Neurology, researchers — including Dworkin — looked at data from 965 people with shingles. The researchers identified five risk factors for developing PHN in people who had been recently diagnosed with shingles:
- Presence of symptoms before the rash appeared, like numbness, tingling, itching, or pain
- Severe pain during the illness’s initial stages
Importantly, the researchers found the more risk factors you have, the greater the risk of developing PHN.
For instance, 17% of women with shingles and 26% of those who had severe pain went on to get PHN. But 50% of women who were over age 60 and had symptoms before the rash, severe rash, and acute pain went on to get PHN.
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Eutectic Mixture Of Local Anesthetics Cream
EMLA cream is a prescription medication made up of a 1-to-1 ratio of 2.5 percent lidocaine and 2.5 percent prilocaine.
A 2018 case study of one person found that EMLA cream may make an effective alternative to lidocaine cream for treating PHN in people with special situations like kidney failure. However, theres not much available research about its effectiveness. Most existing research is from the 1980s and 90s.
A doctor can give you specific instructions on how to use EMLA cream.
What Are The Symptoms Of Postherpetic Neuralgia
The signs and symptoms of postherpetic neuralgia are generally limited to the area of your skin where the shingles outbreak first occurred. The most common areas are in a band around the trunk of the body, usually on one side. It may also occur on the face.
The pain associated with postherpetic neuralgia is varied. It can range from discomfort to very severe. The pain is often described as burning, stabbing, or gnawing.
Patients with the condition often cant bear the slightest touch, even clothing on the affected skin can be painful. In some cases, the sensation may be in the form of either hypersensitivity or decreased sensation. It is rare, but patients may also experience muscle weakness, tremors, or paralysis if the nerves involved also control muscle movement.
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Opt For Otc Pain Relievers
Over-the-counter options like Tylenol can ease the discomfort of shingles rash and even mild PHN. At least for early pain, we often use non-steroidal anti-inflammatory drugs , like ibuprofen or naxopren, Dr. Auwaerter notes. Theyre easy to pick up at any drugstore, but theyre not always ideal for frequent and/or long-term use. NSAIDs can cause stomach irritation and stomach ulcers, and can harm the kidneys unless taken with large volumes of water. If you experience abdominal pain or constipation, ask your doctor to help you find another option.
What Are The Risk Factors For Postherpetic Neuralgia
Age is a high-risk factor for postherpetic neuralgia. The older a person is when shingles develops, the more likely it is that the individual will develop postherpetic neuralgia. People over 60 years of age have about a 60% chance, while people 70 or older have about a 75% chance, of developing postherpetic neuralgia after getting shingles.
People with a family history of close relatives who developed postherpetic neuralgia are at a higher risk of developing this painful condition.
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Why Does The Pain Persist In Some People
The symptoms of PHN can last for several months in some people. Shingles causes inflammation of the nerve. Pain can be expected whilst the rash and inflammation occur. However, it is not clear why some people continue to have pain when the inflammation has gone. It is thought that some scar tissue next to the nerve, or in the nearby part of the spinal cord, may be a factor. This may cause pain messages to be sent to the brain.
Causes Of Shingles Pain
Causes of Shingles Pain
The main cause of shingles pain is a viral infection of the nerve root. If you ever had chickenpox, the virus will remain dormant in your body for the rest of your life. As you grow older, your immune system becomes weaker and suppressed from medications or other procedures such as chemotherapy. When your immune system gets weak, the virus can reactivate, causing shingles pain.
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How Can This Pain Be Managed
If your doctor is able to identify an underlying cause for the neuropathic pain, treating it may reduce and even eliminate the pain.
For example, diabetes is a common cause of neuropathic pain. Proper diabetes care which includes a healthy diet and regular exercise may eliminate or reduce neuropathic pain.
Taking care of blood sugar levels can also prevent worsening pain and numbness.
Are There Treatments I Can Put On My Skin
You might find relief with topical treatments. You can talk to your doctor about:
Creams: Some of these contain capsaicin, the ingredient in cayenne pepper that gives it a kick. Examples are Capsin and Zostrix. You can buy this over the counter but make sure your doctor knows if you plan on using these.
Patches: Capsaicin is also in Qutenza, which is applied via a patch for one hour every 3 months. You need to visit the doctorâs office for this.
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Who Is At Risk Of Getting Shingles
Shingles typically affects older people, but it can also occur in healthy younger persons and even in children. Those whose immune systems have been weakened by cancer, HIV infection, AIDS, or treatment with certain medicines are also at increased risk of getting shingles.
- Anyone who has had chickenpox is at risk of getting shingles later in life. About 1 in 3 people who have not been immunised against chickenpox or shingles will get shingles in their lifetime.
- Shingles usually affects older people. The older you are if you get shingles, the higher your risk of getting serious disease. People who have a weakened immune system are also at risk of getting more severe disease, even if they are young.
- Women have a higher risk of getting shingles than men.
- Most people who develop shingles have only 1 episode during their lifetime. However, you can have shingles more than once.
An attack of shingles during pregnancy will not harm the unborn baby. The mother is already carrying the varicella zoster virus before developing shingles and there is no increase in the risk of passing it on to the fetus if shingles develops. However, an attack of chickenpox during pregnancy can be serious and requires urgent medical attention.
Treatment Of Herpes Zoster
The treatment of herpes zoster has three major objectives: treatment of the acute viral infection, treatment of the acute pain associated with herpes zoster and prevention of postherpetic neuralgia. Antiviral agents, oral corticosteroids and adjunctive individualized pain-management modalities are used to achieve these objectives.
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What Are The Complications Of Shingles
The most common complication of shingles is long-term nerve pain called postherpetic neuralgia. Long term nerve pain occurs in the areas where the shingles rash was, even after the rash clears up. It can last for months or years after the rash goes away. The pain can be very severe and can interfere with daily life. Read more about pain after shingles.Shingles on the face may lead to complications involving the eye, including blindness. Very rarely, it can also lead to pneumonia , hearing problems, or brain inflammation .
What Are The Pain Complications Of Shingles
Pain, itching, and tingling may continue for several months after the rash healing. At the same time, the pain that remains after the rash has healed may be the most severe complication of shingles. Itching, burning, and pain along the nerves that affect the eyes, nose, mouth, and throat can cause temporary and permanent problems.
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How Is Nerve Pain Diagnosed
The main way your doctor will diagnose nerve pain is by listening to you and examining you.
In the examination, they will probably test your nerves by testing the strength of your muscles, checking your reflexes, and by seeing how sensitive it is to touch.
You may be asked to have tests like:
- blood tests to check your general health and look for underlying conditions
- nerve conduction studies which measure how quickly your nerves carry electrical signals
- a CT scan or an MRI scan to look for anything that could be pressing on a nerve
Go With Gabapentin For Phn
If you do have the lasting nerve pain of PHN, some doctors will prescribe anti-seizure medications, including Neurontin or Lyrica . Even though they were developed as anti-seizure medicines, they can help modulate the nerve pain until the nerves can heal, Dr. Auwaerter explains. These treatments can reduce pain signaling from the nerves to the brain by calming your neurotransmitters for a short time. They are FDA-approved as an effective treatment for PHN. Like antivirals, they require frequent daily dosing, usually three times per day.
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